Remote Senior HEDIS Quality & Audit Lead

Centene Corporation; United States; Remote; USD 70,000 - 126,000; Full time

Benefits offered by this job

Remote work within the continental US

Competitive pay and benefits

Job summary

Centene Corporation seeks a Senior HEDIS Quality & Audit Analyst to serve as the enterprise expert for HEDIS quality oversight, audit readiness, and submission support. This role operates with autonomy, interpreting regulatory requirements and guiding audit processes across plans, auditors, and stakeholders.

The ideal candidate leads NCQA audit workstreams, manages evidence/communications, and drives improvements in submission accuracy and risk mitigation.

Qualifications

• Bachelor's degree in healthcare or related field required
• Master's degree preferred
• 4+ years related experience in HEDIS, quality audits or regulated healthcare environments required
• Project management experience in HEDIS, regulatory, audit or quality improvement preferred

Responsibilities

• Serve as a senior subject matter expert for HEDIS quality oversight, audit readiness, and submission support activities.
• Lead complex NCQA audit workstreams, including roadmaps, Section 5 documentation, measure-specific evidence, CAHPS and auditor communications.
• Interpret and apply federal and state regulatory requirements to HEDIS documentation, workflows, and data use.
• Provide expert guidance on reporting population applicability/management, measure selection, and submission requirements.
• Identify, assess, and mitigate audit and submission risks; lead root cause analyses and corrective actions for high-risk issues.
• Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
• Develop and maintain enterprise standards, templates, controls, and documentation for audit-defensible outcomes.
• Escalate complex audit findings and regulatory interpretation questions as needed

Skills

HEDIS expertise

Audit leadership

Regulatory interpretation

Submission management

Education

Bachelor's degree in healthcare

Master's degree in healthcare

Job description

Centene Corporation seeks a Senior HEDIS Quality & Audit Analyst to serve as the enterprise expert for HEDIS quality oversight, audit readiness, and submission support. This role operates with autonomy, interpreting regulatory requirements and guiding audit processes across plans, auditors, and stakeholders.

The ideal candidate leads NCQA audit workstreams, manages evidence/communications, and drives improvements in submission accuracy and risk mitigation.